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Induced membrane technique with plate fixation has a lower complication rate than bone transport over a plate for segmental tibial defects larger than 5 cm

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The treatment of segmental tibial bone defects remains a surgical challenge. While Bone Transport (BT) and Induced Membrane Technique (IMT) are effective strategies for regenerating bone, there are few comparative studies between them. This investigation undertakes a comparative analysis of BT and IMT for large segmental tibial defects stabilised through plate fixation.

Materials and methods

Patients with segmental tibial defects exceeding 5 cm were prospectively enrolled from 2008 to 2021 in a single institution, with a minimum follow-up duration of two years. All patients underwent either BT or IMT with plate fixation of the tibia. Procedural success, primary union as well as bone and functional outcome scores were compared. Complications, including non-unions, joint contractures and deep infections requiring surgical intervention, were also compared.

Results

41 patients were recruited in total. 28 patients underwent Bone Transport Over a Plate (BTOP), while 13 patients underwent IMT with Plate fixation (IMTP). The procedural success rate trended higher in IMTP compared to BTOP (100% vs. 85.7%). The primary union rate also trended higher in IMTP compared to BTOP (92.3% vs. 79.2%). BTOP and IMTP achieved similar rates of satisfactory bone outcome scores (78.6% vs. 84.6%) and functional outcome scores (75% vs. 76.5%). There was no statistical difference between procedural success, primary union, bone and functional outcome scores. The complication rate in BTOP was 78.6% (22 of 28), including five docking site or regenerate non-unions, eight deep infections and nine joint contractures. IMTP had a 38.5% (5 of 13) complication rate, including one non-union, two deep infections and two joint contractures. The complication rate was 2.04 times higher in BTOP compared to IMTP (p = 0.0117).

Conclusions

BTOP and IMTP are both equally effective techniques for regenerating bone in large tibial bone defects. However, IMTP may be a safer procedure than BTOP, with a lower probability of requiring additional procedures to address complications.

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Acknowledgements

This research was supported by a grant of Korea Health Technology R&D Project through the Korea Heath Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HR22C1832).

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No funding was provided for this study.

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Author notes

  1. Yong-Cheol Yoon

    Present address: Orthopaedic Trauma Division, Trauma Center, Gachon University, College of Medicine, Incheon, 21565, Republic of Korea

Authors and Affiliations

  1. Department of Orthopaedic Surgery. Woodlands Health, National Health Group, Singapore, Singapore

    Daniel W.R Seng

  2. Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea

    Chang-Wug Oh & Joon-Woo Kim

  3. Department of Orthopaedic Surgery, Severance Children’s Hospital, Yonsei University, College of Medicine, Seoul, 03722, Republic of Korea

    Kyeong-Hyeon Park

  4. Department of Orthopaedic Surgery, School of Medicine, Korea University , Korea University Guro Hospital, Seoul, 10408, Republic of Korea

    Jong-Keon Oh

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Correspondence to Chang-Wug Oh.

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This study received approval from Institutional Review Board (IRB No: KNUH 2023-07-042).

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Seng, D.W., Oh, CW., Kim, JW. et al. Induced membrane technique with plate fixation has a lower complication rate than bone transport over a plate for segmental tibial defects larger than 5 cm. Arch Orthop Trauma Surg 144, 1881–1888 (2024). https://doi.org/10.1007/s00402-024-05262-0

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